This step lets you add all the providers associated with the claim.

To add providers, click Add new; the Add provider modal opens. Complete the modal using the information below.

Note: Fields are dynamically displayed based on claim type you are entering, then on the provider type selected.

Step/Section	Field	Definition
Providers - Add provider	Provider type	Choose a provider type from the dropdown. The dropdown choices are as follows Claim type(s) Provider type Professional, Institutional, Dental Billing Professional, Institutional, Dental Referring Professional, Institutional, Dental Rendering Professional, Institutional, Dental Service facility Professional, Institutional, Dental Supervising Institutional Operating Institutional Other operating Institutional Attending Dental Assistant surgeon

Providers - Add providerTax identification number*/Provider NPI*

Enter the provider’s tax identification number or NPI (as required). You may also enter the provider’s name and select from the list displayed.

Note: Once the tax identification number/NPI is chosen, the remaining fields are auto populated, assuming the data is available in the provider system.

Providers - Add provider - DETAILSLaboratory or facility nameEnter the laboratory or facility nameProviders - Add provider - DETAILSLast name or organization name*Last name or organization name of the providerProviders - Add provider - DETAILSFirst name (if applicable)First name of the providerProviders - Add provider - DETAILSMiddle nameMiddle name of the providerProviders - Add provider - DETAILSName suffixProvider’s suffix (Jr., III, etc.)Providers - Add provider - DETAILSPrimary specialtyThe taxonomy code representing the provider’s specialtyProviders - Add provider - DETAILSEntity type*Choose person or non-personProviders - Add provider - DETAILSProvider NPI*Enter the provider’s NPI. Providers - Add provider er - DETAILSInternal IDEnter the providers internal ID.Providers - Add provider - ADDRESSAddress line 1The first line of the provider’s addressProviders - Add provider - ADDRESSAddress line 2The second line of the provider’s addressProviders - Add provider - ADDRESSCityThe provider’s cityProviders - Add provider - ADDRESSStateThe provider’s state. Choose from the dropdown list.Providers - Add provider - ADDRESSZipThe provider’s zip code

• You may enter multiple referring providers by clicking the ⊕ at the bottom of the Add provider modal
• If the Pay To address is different from the billing provider’s address, click on the Differs from billing provider checkbox and enter the address information.

After completing the provider information, click the Add provider button on the bottom right of the modal. The provider is added to the list on the Providers slot:

If you need to edit a provider you have added, click the gear icon. If you wish to delete a provider you have added, click the trash can icon.

Additional providers may be added by clicking the Add new in the top right corner of the Providers slot and populating the modal.

Once you have entered the provider information, click Next on the bottom right of the screen to advance to the next step.

• Manual claim entry